Eligibility requirements for both MAGI and Non-MAGI applicants remain the same. However, the application procedures for Non-MAGI Medicaid and program requirements have been modified under COVID-19. For HRA’s FAQ for non-MAGI applicants/recipients, visit: https://www1.nyc.gov/site/hra/help/dss-covid19-faqs.page.
If you are a Benefits Plus subscriber, for additional information on Medicaid, refer to Benefits Plus, Health Programs, Medicaid. For subscription information visit: https://bplc.cssny.org/home/subscription_options.
No Cost Sharing for COVID-19 Testing & Treatment
Medicaid must cover, without any cost-sharing expenses, the following: COVID-19 testing, testing-related services, and COVID-19 related treatment for Medicaid enrollees, which include vaccines, specialized equipment and therapies.
Changes in Non-MAGI Application Procedures
DEFINING NON-MAGI MEDICAID APPLICANTS
The following individuals are classified as non-MAGI Medicaid
- Individuals 65 or over (not a parent/caretaker relative of minor children);
- Disabled individuals with Medicare (not a parent/caretaker relative of minor children);
- Blind individuals with Medicare (not a parent/caretaker relative of minor children).
There is an exception, an individual/couple who is aged, disabled or blind with Medicare who is a parent or caretaker relative with children under 19 or who is pregnant may be classified as MAGI Medicaid.
To learn more about non-MAGI vs. MAGI Medicaid, refer to Benefits Plus, Health Programs, Medicaid, MAGI Medicaid vs. Non-MAGI Medicaid.
Additional guidance is found at https://health.ny.gov/health_care/medicaid/covid19/factsheets/eng_guide_med_cons_enrolled_thru_ldss.htm.
Closure of Local Medicaid Offices
Many local Medicaid offices are closed for in-person assistance. However, in NYC, one office remains open in each borough for in-person emergencies. To find open locations, visit: https://www1.nyc.gov/site/hra/locations/medicaid-locations.page.
The Medicaid application is the DOH-4220, Access NY Health Care and the DOH-4495, Access NY Supplement A.
- DOH-4220: https://www.health.ny.gov/forms/doh-4220.pdf
- Supplement A: https://www.health.ny.gov/forms/doh-5178a.pdf
- Spanish DOH – 4220: https://www.health.ny.gov/forms/doh-4220_es.pdf
Submitting an Application Via Fax
During the COVID-19 emergency, non-MAGI Medicaid applicants are able to submit a Medicaid application via fax to 917-639-0732. In addition, young adults under age 26 who were formerly in foster care may submit an application via fax.
Individuals who have an immediate need for home care, can fax their application and home care request to 917-639-0665.
Submitting an Application via Facilitated Enrollers
Non-MAGI Medicaid applicants may also contact a facilitated enroller (FE) to apply for Medicaid via telephone. The FE, community-based organizations contracted by NYS to assist the aged, blind and disabled population with application/ recertification assistance, must send the individual a copy of the Medicaid application to use during the required telephone interview, as well as the DOH form 5147, Submission of Application on Behalf of Applicant, which allows the FE to sign the application on the applicant’s behalf. Both these forms can be sent by standard mail or by email, if acceptable to the applicant.
The applicant must sign and return both documents prior to conducting the interview. The form can be scanned and emailed back to the FE ABD agency.
Applicants can attest to all elements of eligibility except immigration status and identity, if the immigration document does not also prove identity, see below, Documentation.
The following agencies serve as facilitated enrollers in NYS:
- Community Service Society – 888- 614-5400 https://www.cssny.org/programs/entry/facilitated-enrollment-for-the-aged-blind-and-disabled-program-fe-abd
- Public Health Solutions – 646-619-6759
- Nassau/Suffolk Hospital Council – 631-656-9783
- Western New York Independent Living – 716-836-0822
During the COVID-19 emergency, if an applicant has missing information, their local district will attempt to contact them via phone or e-mail (the district does not need to receive the information in writing and can accept information verbally).
If the local district is unable to contact the individual, the local district will send a written request for the missing information with a due date of no less than 10 days.
Local districts must allow for self-attestation for all eligibility criteria, including retirement accounts and annuities, but not for citizenship/immigration status on applications.
In addition, individuals applying for Medicaid coverage of nursing home care can attest to income and resources during this emergency, including attesting to any transfer of assets in the look-back period.
Self-attestation applies to both initial applications or for a request for an increased coverage and redetermination.
Applicants whose citizenship status is not verified through data sources will be given an opportunity to submit documents later.
Applicants that need to prove immigration status/identity should submit the required documentation. However, if an applicant is not able to submit documentation due to the COVID-19 emergency, the application should still be submitted and processed. Applicants will be granted a 90-day reasonable opportunity to provide the required documents. If the COVID-19 emergency has not ended and supporting documents have not been received at the end of the reasonable opportunity period, coverage should be extended for a second 90-day period.
Individuals in need of a disability determination, for example to establish a supplemental needs trust, should contact their local district to assist with the necessary documentation to process the disability determination.
CONDITION OF ELIGIBILITY REQUIREMENTS
Application for Other Benefits
During the COVID-19 emergency, applicants will not be required to apply for Medicare, Social Security; in addition, referrals for Veterans benefits have been suspended.
Applicants with an absent parent must not be referred to child support and will not be required to comply with child support requirements as a condition of Medicaid eligibility.
Third Party Health Insurance
Applicants will not be required to provide third party health insurance information and local districts are not required to make new cost-effective determinations for possible reimbursement.
If a signature on the Access NY Application and/or Supplement A cannot be signed by the applicant (or the applicant’s spouse) and the applicant is in a hospital or nursing home, the application can be signed by someone acting on behalf of the individual. The individual who is signing on behalf of the application must complete Submission of Application on Behalf of Applicant (DOH-5147 for NYS (http://coverage4healthcare.org/insurance_over_65/authorized_representative.pdf); MAP3044 for NYC) and must note the applicant cannot sign the form due to access issues/COVID-19 emergency.
If the applicant can sign the application, then the applicant must sign the DOH-5147 him/herself to authorize another person or the facility to apply on behalf of the individual.
MAGI Medicaid includes the following population groups:
- Pregnant women;
- Dependent children under the age of 19;
- Parents/caretaker relatives of children under 19;
- Applicants 65 and over, as well as applicants with Medicare, are typically budgeted as non-MAGI.
- However, if such an applicant is a parent/caretaker relative with children under 19, s/he may choose to be classified as MAGI and MAGI budgeting rules and application and renewal procedures would apply.
- Singles/Childless couples ages 19 through 64 who are not entitled to or enrolled in Medicare.
- This includes SSDI beneficiaries who do not yet have Medicare
These individuals continue to submit an application via the NY State of Health at https://nystateofhealth.ny.gov or by calling 1-855-355-5777, there is no change.
Changes in Medicaid Renewal Periods
NO DISENROLLMENTS DURING THE COVID-19 EMERGENCY
During the COVID-19 emergency beginning March 18, 2020, Medicaid cases will be closed for failure to renew or for failure to provide documentation through the end of the COVID-19 emergency, unless the individual voluntarily cancels his/her Medicaid, or moves out of NYS. In addition, any person who enrolls in Medicaid during the COVID-19 emergency will not be disenrolled. This provision applies regardless of any changes in circumstances that would otherwise have resulted in coverage termination. Individuals do not need to take any action to keep their coverage. However, if an individual informs the district of a change that results in an increase in Medicaid coverage, the district is required to process the change.
Any case that is closed will be re-opened and coverage restored to ensure no gap in coverage. If a renewal, notice or other correspondence is returned to the district with no forwarding information, the district must maintain coverage for the case for the duration of this emergency.
This renewal extension applies to all renewal cases including nursing home residents, Medicare Savings Program, Medicaid Buy-In for Working People with Disabilities, SSI recipients who lose their SSI eligibility and Cash Assistance recipients who loses their eligibility for Cash Assistance.
Medicaid cases are being extended and individuals will NOT be required to renew their Medicaid eligibility.
All active Medicaid cases with authorization and coverage dates ending in March, April, May and June will be systemically extended by 12 months. Currently there is no extension for July or August renewals.
The renewal extension applies to all renewal cases including Office of Mail Renewal, Managed Long Term Care, Nursing Home Eligibility, Medicare Savings Program, and Medicaid Buy-In for Working People with Disabilities.
Cash Assistance and SSI Cases
SSI cash cases and any Cash Assistance/Medicaid cases that require a separate Medicaid eligibility determination will have their Medicaid coverage extended. No redeterminations are required at this time.
Local districts should not increase an individual’s spenddown liability, as this is considered a reduction in coverage.
Individuals who met their spenddown in March will have coverage extended for six months. Individuals who have a spenddown and have been unable to submit a bill or payment due to the COVID-19 emergency should contact their local district; in NYC they should call the MICSA Surplus Helpline at 929-221-0835. The individual should include the following information:
- Phone number
- If submitting a bill, provide the name of the provide, the date of the service, and the amount of the bill
- If submitting a payment, indicate the amount of the payment.
Clients will receive a call back if additional information is needed. If the requested information is provided, coverage will be extended for 6 months
Changes in Program Requirements
CHILD SUPPORT REQUIREMENTS
Medicaid recipients will not be required to comply with child support requirements to apply for or maintain Medicaid coverage. Clients can call 929-221-7676 or email firstname.lastname@example.org , or write to the NYC Office of Child Support Services, PO Box 830, Canal Street Station, New York, NY 10013 and state their willingness to comply. Clients should provide their name, case number and contact information. Demonstrated compliance is suspended until further notice.
THIRD PARTY HEALTH INSURANCE
Individuals with third party health insurance will not be required to provide
information concerning available insurance.
Transition of Cases to and from NY State of Health
WMS TO NY STATE OF HEALTH
Effective April 2020, upstate transitions from WMS to NYSOH are suspended. For NYC, individuals who are transitioned to NYSOH but who do not gain Medicaid coverage through NYSOH will have their case re-opened on WMS.
NY STATE OF HEALTH TO WMS
The monthly referrals of WMS for those individuals turning 65 with an active Medicaid case on NYSOH were suspended as of March 19, 2020. However, referrals of those turning 65 to NYSOH may still be sent to local districts because another identifier triggered the transition to WMS.
All other referrals from NYSOH to WMS will continue at this time, including “HX Facility” referrals for individuals who require long term care services and supports. Refer to Benefits Plus, Health Programs, Medicaid, Medicaid Renewal for MAGI Medicaid Recipients.
Changes to Home Care Services
Home care recipients may want to temporarily reduce their current hours of home care or even pause their home care to limit their exposure to the coronavirus. The NYS Department of Health has issued a directive on April 23rd that states that home care recipients can make a temporary change to their care plan during the COVID-19 emergency by pausing or reducing the number of hours of home care. For more information visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-04-23_guide_volplanofcare.pdf.
For additional information on Home Care cases visit: https://health.ny.gov/health_care/medicaid/covid19/docs/2020-03-18_guide_authorize_cb_lt_services.pdf.
During the COVID-19 emergency, consumers who requested a fair hearing with aid continuing status on or after March 18th, must be maintained with the same coverage during the period of the emergency.
How COVID-19 Cash Aid Impacts Medicaid
ECONOMIC IMPACT PAYMENTS
The CARES Act Economic Impact payments (EIP) (up to $1,200 per individual, $500 per qualifying child) will not count when determining eligibility for Medicaid. However, twelve months after receiving the benefit any remaining money will count as a resource when determining eligibility for Non-MAGI Medicaid applicants/ recipients. Note that MAGI recipients are not subject to a resource test.
PANDEMIC UNEMPLOYMENT COMPENSATION
The $600 per week in Pandemic Unemployment Compensation will not count when determining eligibility for Medicaid. However, twelve months after receiving the benefit any remaining money will count as a resource when determining eligibility for Non-MAGI Medicaid applicants/recipients. The base Unemployment Insurance benefit, and the weekly Pandemic Unemployment Assistance amount, does count as unearned income.